Decision making in periodontics

If you get a spare few minutes you must read books by Malcolm Gladwell. His work is easy reading but full of amazing ideas that challenge the way we view the world. His latest book, Blink, really got me thinking.

As many of you already know, one of my beliefs is that we are over recording periodontal information, taking away important time that can be used to better serve our patients.

It also creates a great deal of confusion in that we are unable to easily cross-reference the pile of numbers and coloured dots that are generated, resulting in a failure to readily identify the periodontal sites that are truly deteriorating and require the focused periodontal care.

Another problem is that it prevents simple transmittance of information between different members of the practice team. In his book Gladwell discusses a crisis in the emergency department at Cook County Hospital in Chicago. The department was overwhelmed during the 1990s, mainly because of the inability of the hospital staff to easily identify patients who were genuinely having a heart attack from the many who were attending with chest pain. As a result, many patients admitted were misdiagnosed.

Clearly it was vital to take time to get the diagnosis right, but failure to reduce the overload in the department would have resulted in far from adequate care for the majority of patients.

At least in periodontics we have time on our side to review the situation and do not have to make judgments in the blink of an eye. To cut a long story short, following a great deal of research it was found that, using an equation involving an ECG reading combined with three urgent risk factors, a decision tree could be developed that ultimately turned out to be far more accurate than the old method in diagnosing patients who were actually having heart attacks and required admittance. This resulted in pressure being taken off the emergency department and overall better care for the many.

So how does this relate to periodontics? Do we really need to record every bleeding site and plaque deposit on six sites on every tooth? How often do we need to do six-point pocket probing depths? Will a BPE give us sufficient information most of the time supplemented with more detail when required? Is some of the recorded information actually obscuring what we are really looking for?

Surely the only true indicator of an active site is the ongoing loss of the periodontal apparatus over a period of time, and this can be picked up relatively quickly if we are seeing a patient routinely. In this situation I am not too concerned whether the bleeding is from the base of the pocket or not. What really matters is that you can collect accurate information efficiently and then translate that data into quality care.

Are we losing site of what really matters? For those of you who hate periodontics and find the collection of data boring, maybe a more focused approach that removes the tedium will help you make quicker and better decisions. That will then allow you to do what you really enjoy whilst not worrying too much about the periodontal status. Your decision will have been made and the care put in place. You might then have the time to read Malcolm Gladwell’s books.

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